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Which of the following is an example of passive aggression?
- A. Clenched fists
- B. Yelling
- C. Jealousy
- D. Intimidation
Correct Answer: C
Rationale: Passive aggression involves expressing negative feelings indirectly, such as through subtle actions or behaviors. While choices A, B, and D involve more direct and aggressive expressions of anger, jealousy is an example of passive aggression where negative emotions are subtly displayed without openly confronting the issue. Jealousy can manifest as resentment, envy, or possessiveness, and is a common form of passive aggression in interpersonal relationships.
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Which of the following interventions is most appropriate when working with the family of a client who is being treated for substance abuse?
- A. Advocate for the client before the family
- B. Provide referrals for community resources and support groups
- C. Take the side of the family before the client
- D. Both B and C
Correct Answer: B
Rationale: When working with the family of a client undergoing substance abuse treatment, it is crucial to support not only the client but also their family. Providing referrals for community resources and support groups is an effective intervention as it helps the family access additional support and information to cope with the challenges related to the client's substance abuse. This empowers the family to enhance their understanding of the situation and develop effective coping strategies. Advocating for the client before the family (choice A) may lead to conflicts and hinder the therapeutic process, while taking the side of the family before the client (choice C) can jeopardize the client's progress and trust. Therefore, the most appropriate intervention in this scenario is to provide referrals for community resources and support groups to ensure holistic care for both the client and their family.
Which of the following actions is most appropriate when working with a client who is extremely angry?
- A. Place a light hand on the client's shoulder to convey understanding
- B. Maintain close proximity to build trust
- C. Temporarily change the subject if the client's behavior is escalating
- D. Close the door to the room to ensure privacy
Correct Answer: C
Rationale: When dealing with an angry client, it is crucial to employ techniques that can help de-escalate the situation or ensure safety while providing care. If the client's behavior is escalating or they are fixating on a particular topic that is fueling their anger, it is advisable to temporarily change the subject. This technique can serve as a distraction from the initial trigger, allowing the client to refocus their thoughts and emotions. Placing a hand on the client's shoulder may not be well-received as physical touch can escalate the situation. Maintaining close proximity might be perceived as confrontational rather than building trust. Closing the door for privacy is important but may not directly address the client's anger or help in de-escalation.
During a discussion about glaucoma at the community center, which comment by one of the retirees would the nurse give a supportive comment to reinforce correct information?
- A. I usually avoid driving at night since lights sometimes seem to make things blur.''
- B. I take half of the usual dose for my sinuses to maintain my blood pressure.''
- C. I have to sit at the side of the pool with the grandchildren since I can't swim with this eye problem.''
- D. I take extra fiber and drink lots of water to avoid getting constipated.''
Correct Answer: D
Rationale: The correct answer is ''I take extra fiber and drink lots of water to avoid getting constipated.'' In individuals with glaucoma, activities that involve straining, such as constipation, should be avoided as they can increase intraocular pressure. Choices A, B, and C are incorrect as they do not align with the management of glaucoma. Driving at night or taking sinus medication are not directly related to glaucoma, and sitting by the pool due to an eye problem does not provide information relevant to managing glaucoma.
Ten minutes after signing an operative permit for a fractured hip, an older client states, 'The aliens will be coming to get me soon!' and falls asleep. Which action should the nurse implement next?
- A. Make the client comfortable and allow the client to sleep.
- B. Assess the client's neurologic status.
- C. Notify the surgeon about the comment.
- D. Ask the client's family to co-sign the operative permit.
Correct Answer: B
Rationale: The client's statement about aliens coming to get them could indicate confusion, which raises concerns about their neurologic status. Since informed consent for surgery requires the client to be mentally competent, the nurse should assess the client's neurologic status to ensure they understand and can legally provide consent. Option A of making the client comfortable and letting them sleep does not address the potential neurologic issue. If the nurse finds the client to be confused, it is essential to inform the surgeon and seek permission from the next of kin if necessary. Therefore, assessing the client's neurologic status is the priority to ensure the client's ability to consent to the surgery.
Before assessing a new patient, a nurse is told by another healthcare worker, "I know that patient. No matter how hard we work, there isn't much improvement by the time of discharge."? The nurse's responsibility is to:
- A. document the other worker's assessment of the patient.
- B. assess the patient based on data collected from all sources.
- C. validate the worker's impression by contacting the patient's significant other.
- D. discuss the worker's impression with the patient during the assessment interview
Correct Answer: B
Rationale: The correct answer is to assess the patient based on data collected from all sources. It is important for the nurse to gather information from various sources to form an objective assessment. Biased assessments by others should be evaluated as objectively as possible by the nurse, considering the potential impact of counter-transference. Documenting the other worker's assessment (Choice A) may be necessary for thorough documentation but should not influence the nurse's independent assessment. Validating the worker's impression by contacting the patient's significant other (Choice C) may not provide an accurate representation of the patient's condition. Discussing the worker's impression with the patient during the assessment interview (Choice D) can introduce bias and may not lead to an objective evaluation.